Predictive factors of residual cholesteatoma in children

The decision on the appropriate surgical technique for treating cholesteatoma in children raises a number of controversial questions, most because of personal convictions rather than because of established data. We attempted to determine which patients are at risk of residual cholesteatoma in order to propose the most rational therapeutic strategy. A retrospective study of 250 children with cholesteatoma or severe retraction underwent surgery between 1986 and 1992. During this period 69 cases of residual cholesteatoma were recorded during a second intervention. After a mean follow-up of 33 months after the final operation, the Kaplan-Meier plot shows a rate of 31% and 34% at 3 and 5 years respectively. The univariate and multivariate (Cox regression) analysis was performed to search for a correlation between residual cholesteatoma development and past history including type of process involved, peroperative findings and surgical technique. Three factors were closely and independently related (p < 0.003) to residual cholesteatoma: invasion of the posterior middle ear, presence of ossicular erosion after excision and presumption of incomplete ablation. Inversely, age, surgical history, extension and nature of the process involved as well as surgical technique had no effect on development of residual cholesteatoma. Only one comparable study has been published where only ossicular erosion was found to be significant on multivariate analysis. The presence of one or more of the three of the factors mentioned above should lead to a second intervention, perhaps after a short delay, whatever the initial technique (open or closed).